Physical Assessment of the Patient with Low Back Pain

Physical Assessment of the Patient with Low Back Pain

Maxim S. Eckmann, M.D. Professor of Anesthesiology and Pain Medicine

UT Health San Antonio, Texas, USA



Nothing to disclose Yes, as follows: X

Faculty Disclosure

Honoraria/Expenses Consulting/Advisory Board

Speakers Bureau Funded Research (Individual) Funded Research (Institution)

Royalties/Patent Stock Options

Ownership/Equity Position Employee Other

AVANOS Dannemiller Abbot, Boston Scientific, SPR

Insight Dental Systems, iKare Holdings UT Health San Antonio

Off-Label Product Use

Will you be presenting or referencing off-label or investigational use of a therapeutic product? No X Yes, as follows:

Goals and Objectives

? Outline an approach for organizing causes of low back pain (LBP) ? Apply organized approach to LBP to select and interpret physical exam

maneuvers and assessments ? Recognize differential evaluation of LBP sources to include:

? Acute vs Chronic LBP ? Assessment of "Red Flags" ? Myofascial LBP ? Facetogenic LBP ? Sacroiliac Pain ? Radicular LBP ? Discogenic LBP ? Vertebral/Sacral Fracture Pain ? Referred Pain ? Non-specific LBP

Impact of Low Back Pain (LBP)

? Fifth most common reason for all physician visits (USA). ? Prevalence

? 25% report at least 1 day LBP in last 3 months ? 7-8% report severe LBP in last year ? 75-85% lifetime prevalence in industrialized society

? Cost

? $26 billion direct health care costs 1998, now >$80 billion ? 2% of workforce compensated for LBP ? 5% of patients w/back pain disability account for 75% of the

total costs.

J Bone Joint Surg Am. 2018;100:368-74

Factors Associated with Low Predictors of Delayed

Back Pain

Recovery

? Heavy lifting ? Twisting and bending ? Physical activity ? Obesity ? Arthritis and osteoporosis ? Pregnancy ? Age > 30 years ? Bad posture ? Stress and depression

? Depression / Anxiety ? Passive coping ? Job Dissatisfaction ? Significant Disability ? Disputed Compensation Claims ? Somatization ? Emotional Distress

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